Japanese health and physical education teachers’ experiences teaching sexuality education at the high school level

Abstract The purpose of this study was to describe and explain Japanese health and physical education teachers’ experiences teaching sexuality education at the high school level. This qualitative study used the interview method, with an in-depth, semi-structured approach. The research sites were Japanese high schools located in the Kanto region of Japan. Participants included eight health and physical education teachers who taught sexuality education at the time of this study. A constant comparative analysis method was used to interpret the data, with three themes emerging from the data: (a) teaching how to avoid unwanted and unexpected pregnancy, (b) be careful about sexual comments and terms that could turn to harassment, and (c) use instructional resources that help students’ transformative learning. Findings suggest that health and physical education teachers must be highly ethical professionals, whose attitudes and actions are focused on what is best for their students while teaching sexuality education. To advance the quality of sexuality education instruction, teachers, administrators, and researchers need clear and focused goals related to the status, quality, and relevance of sexuality education programs and curricula.


Introduction
According to Goldman (2011), many public schools neglect and minimize quality sexuality education. Teaching sexuality is challenging, because teachers in public schools ask questions about students' experiences which are socially constituted as private, embarrassing, dangerous, and/or subsequently problematic (Allen, 2009).
According to the Future of Sex Education (FoSE) Initiative (2020), sexuality education in the United States aims to strengthen young adolescent's capacity to challenge harmful stereotypes related to social, racial, and reproductive justice. In addition, it seeks to introduce equity, and attempts to include a wide range of viewpoints without stigmatizing any group. The guiding principles and values of the The Future of Sex Education (2020) encourage health and physical education teachers to guide their students to learn comprehensive, developmentally appropriate, and culturally appropriate practices in sexuality education, which may include challenging and/or uncomfortable conversations and discussions. Additionally, studies in European countries (e.g., United Kingdom, Estonia, and Finland) have shown that comprehensive sexuality education programs have led to a reduction in teenage pregnancy and abortions (Paton et al., 2020).
When looking at Asian countries in comparison to the United States and Europe, health and physical education teachers in Japan are hesitant to teach comprehensive sexuality education because of the focus on biological and physiological topics related to pregnancy, abortion, and sexual health behaviors, even though this content meets the needs of high school students (Sato, Kataoka, Burge-Hall, Furuta, Izumi, Tomura et al., 2022a). Further, Japanese curriculum and standards focus on more traditional, abstinence-based sexuality education terminology that create a lack of clarity and are associated with negative image, gender biases, and stereotypes (Hendricks & Howerton, 2011). Culturally, Japanese teachers tend to have conservative values that impose personal and ethical restrictions on sexuality education (Hashimoto et al., 2012), resulting in Japanese high school students remaining relatively uninformed about sexual relationships, and lacking an open discussion on sexuality, as it is regarded as taboo and against social and cultural norms (Sato, Kataoka, Burge-Hall, Furuta, Izumi, Tomura et al., 2022a, 2022a. Research in this area of sexuality education has focused on health and physical education teachers' in secondary schools in European countries. However, there are limited studies that qualitatively investigate health and physical education teachers' current status of teaching sexuality education in Asian countries, especially in Japan at the high school level. Therefore, the purpose of this study was to describe and explain Japanese health and physical education teachers' experiences teaching sexuality education at the high school level. The research questions guiding this study were: a) What are Japanese health and physical education teachers' experiences teaching sexuality education at the high school level?, and b) How do sexuality education experiences influence Japanese teachers' perspectives on teaching secondary school students?

Theoretical framework and purpose
This study used the theory of teacher development (Katz, 1972), which explains how teachers develop knowledge and skills and grow professionally. The theory of teacher development helps researchers find the clues to interoperate complex teacher development processes, including different perspectives, experiences, and ideas (Katz, 1972). According to Ylimaki (2012), teachers must prepare their students to live as critical citizens in society and must recognize that their students meet goals and objectives only when the teachers assign students to inclusive, heterogeneous classrooms that provide all students access to a rich and engaging curriculum in sexuality education. In this study, we utilize the theory of teacher development to understand the perspectives, experiences, and ideas of teachers related to teaching sexuality education.
According to Katz (1972), there are four developmental stages of teacher development, including survival, consolidation, renewal, and maturity. Fuller et al. (1974) explains that the survival stage of teacher development indicates a high level of concern regarding competence to be successful in the classroom. In the sexuality education context, the survival stage is indicated when health and physical education teachers are concerned that they do not have the knowledge, skills, or competence to succeed in the classroom when tasked with covering sexual health content. More specifically, this stage allowed the teachers to begin to construct meaning and knowledge that they need emotionally safe places for learning and growing (Beatty, 2007;Hargeaves, 2004) through students' interests as well as pedagogical excellence. They also have opportunities to learn and reflect their own values, beliefs, information, and assumptions through continuing conversations with their students in sexuality education (Harris, 2003). In the consolidation Katz (1972Katz ( , 1977 explains that teachers plan and execute lessons that meet the needs of students in the class, focusing on making procedural changes based on their students' learning progress. Teachers in the consolidation stage may exchange ideas with other teachers in order to develop a network of support, and to accomplish their goals and objectives (Stroot & Whipple, 2003). Japanese teachers who live in collective culture in Asian countries (e.g., Japan or China) emphasize interdependence of self and social harmony in order to meet teachers' social obligations and responsibilities (Qu & Zhang, 2005). Nishimura (2009) stated that there are two types of teaching behaviors of which teachers need to be aware. First, important teaching behaviors that have an outcome that leads to achieving the teachers' own goals and objectives. And second, by contrast, urgent teaching behaviors that are often associated with the achievement of group members' instructional goals and objectives. Japanese teachers need to develop action and priority plans, prioritize lessons, and evaluate the importance and urgency of various teaching behaviors (Nishimura, 2009). Therefore, the teachers in this stage may utilize student and teacher feedback to modify lessons, engage in the exchange of ideas and learning with other colleagues to improve lesson quality, and strengthen their skills and knowledge related to tracking student progress.
In the renewal stage, teachers begin to exhaust the initiatives utilized in the consolidation stage, and move to developing greater interest in finding new materials, techniques, approaches, and ideas through professional development opportunities offered by school districts and local organizations (Katz, 1972). Teachers at this stage are ready to investigate their professional identity, including elements such as self-image, job motivation, core responsibilities, self-esteem, perceptions of teaching, and subject pedagogy (Lee & Yin, 2011;Van Veen & Sleegers, 2009). In addition, teachers at this stage may focus on skill elements such as mentoring, teaching adults, collaborating with others (Katzenmeyer & Moller, 2001), and seeking best practices offered in workshops and professional development trainings to renew their understandings and skills (Ladky & Peterson, 2008). In the sexuality education context, teachers in the renewal stage may attend workshops and trainings on specific sexuality content, programs, and initiatives to further their learning and abilities. Finally, in the maturity stage, teachers become more competent and mature, and can apply their knowledge and skills to solve various problems in different settings (Katz, 1972). In relation to sexuality education, teachers in this stage are expected to understand a classroom situation and evaluate students' learning without external assistance, while also reshaping their duties and responsibilities to remain relevant (Anand, 2018). In addition, according to Anand (2018) teachers in this stage should be asking profound and abstract questions representing a more meaningful search for insight, perspective, and realism about facilitating sexuality education and its impact on students, including peer relationships and collaborative problem solving.
According to Lam and Yan (2011), teacher development is often influenced by complex factors including teachers' past experiences, school-based support, and teacher training experiences. This study used the theory of teacher development and the critical lens it provides to examine teachers' experiences with sexuality education, including how new insights and perspectives are constructed regarding how to facilitate student learning in sexuality education classes.

Research design
This qualitative study used the interview method with an in-depth, semi-structured approach (Seidman, 1998), because qualitative inquiry allowed the researchers to explore real world school programs in relation to teaching and learning, gaining insight from close contact with the teachers and programs to capture the experiences related to teaching sexuality education in an in-depth manner (Patton, 2003). Denzin (1978) explains that the researchers would be able to describe and understand both externally observable behaviors and internal states (including opinions, values, and symbolic constructs) of health and physical education teachers through the teacher development process. The lead author conducted semi-structured interviews with five participants who identified as health and physical education teachers with responsibilities in teaching sexuality education at the high school level in Japan. The interview method is used to gain insight into pedagogical and social phenomena experienced by teachers in educational contexts, offering participants an avenue to express what they think in their own words (Seidman, 1998). Semistructured interviews are unique, in that the researcher acquires qualitative data through asking questions that follow an interview guide, with the opportunity to follow trajectories in the conversation that may diverge from the guide. This potential divergence provides the freedom for identifying new ways of seeing and understanding a topic (Gay, 1996).

Course of study of sexuality education at high school level in Japan
In the course of study of sexuality education at the high school level outlined by the Ministry of Education, Culture, Sport, Science, and Technology (Ministry of Education, Culture, Sport, Science and Technology [MEXT], 2019), high school health and physical education teachers are assigned and required to teach two components of sexuality education: (a) lifelong health-including adolescence and health, and marriage relationships and health; and (b) modern society and health-including characteristics of sexually transmitted infection (STI) prevention methods. In Japan, however, there are restrictions on teaching facts about human reproduction, leaving teachers to navigate the required components of sexuality education, and the school district guidelines and expectations. For example, in some city school districts, health and physical education teachers are not allowed to teach the names of the sex organs, explain sexual intercourse, or introduce condoms (Sato, Kataoka, Burge-Hall, Furuta, Izumi, Tomura et al., 2022a). Additionally, in another district, menstruation is not taught at the high school level because the health and physical education teachers are scared of being attacked (Leung & Lin, 2019). In this example, the teachers' pedagogical competency and personal factors (e.g., knowledge, skills, perceived self-efficacy, and outcome expectations) may impact student knowledge and understanding of processes and behaviors related to sexuality (Allen, 2009). Similarly related to pedagogical competency and personal factors, research indicates that health and physical education teachers are not expected to adopt specific teaching styles and strategies when they teach their classes, but instead can choose and create the best pedagogical and didactic practices according to circumstances and abilities (Scriven, 1994). Often, health and physical education teachers feel uncertain about the theoretical basis and associated pedagogies in sexuality education related to the age, development, and cognitive ability of their students (Goldman, 2011).

Japanese educational system
Japanese secondary schools (junior high school: Chugakko; high school: Kotogakkou) provide six years of education for students ages 12 to 15 (junior high school) and 15 to 18 (high school). A typical school year in Japan starts on April 1 st and ends the following March. The whole-school curriculum in Japan consists of Japanese, English, social studies, mathematics, science, life studies, music, arts and handicrafts, homemaking, moral education, and health and physical education (health and physical education are combined and considered one subject area in Japan). The MEXT in Japan promotes health education as an academic subject to support positive health behaviors in students, families, and local communities. Because health education is recognized as an academic subject by MEXT, students can learn and explore health education concepts in the school setting.
Japanese health education content focuses on a variety of responses to health-related problems, including instruction about tobacco and alcohol use and abuse, drug abuse, sexual health behaviors, and communicable and noncommunicable disease. Health education lessons are typically 50 minutes long, with a total of 16 mandatory health education hours per year (accumulating to 48 mandatory hours over the course of three years) as a part of the graduation requirements for all public junior high schools (Ministry of Education, Culture, Sport, Science and Technology [MEXT], 2018). High school health education lessons are also 50 minutes long, with a total 70 mandatory hours required during the first two years of high school. Specifically related to sexuality education, each school and school district has the autonomy to determine the number of hours appropriated for sexuality education for each grade of students, and determines what content to teach in sexuality education lessons. MEXT requires high schools to use health education textbooks that include content related to human sexual anatomy and physiology, sexuality related behaviors, the human reproductive system, and pregnancy and STI prevention (Ministry of Education, Culture, Sport, Science and Technology [MEXT], 2019). Moreover, health education textbooks in high schools support the overarching concept that high school students understand their sexuality and their relationships, which will improve adolescents' sexual health and overall quality of life (Ministry of Education, Culture, Sport, Science and Technology [MEXT], 2019).

Setting and participants
The research sites used in this study were Japanese high schools located in the Kanto and Tokai regions of Japan. There were eight health and physical education teachers who taught sexuality education at the time of this study. A criterion sampling strategy was used. The logic of criterion sampling was to select and investigate all cases that met predetermined criterion of importance or interest (Patton, 2003). In this study, all health and physical education teachers who taught sexuality education in health education classes were identified. Of the eight health and physical education teachers (age range between 25-27) within their school districts, five (four male and one female) voluntarily participated in this study. Pseudonyms of the five participants, and their demographic backgrounds, are indicated in Table 1. The lead researcher received approval to conduct this study from the University's institutional review board and secured signed consent forms from all five participants.

Data collection
Face to face and online face to face interviews. Semi-structured interviews were conducted with all participants. Interviews were intended to be completed using a face to face in person interviewing approach, however the research team determined that online face to face was the prudent course of action due to safety concerns related to the COVID-19 pandemic. As such, all interviews were conducted in the online face to face format using the Microsoft Teams communication and collaboration platform. During the interviews, the lead researcher asked participants thoughtful questions about the environment, lesson content, teaching strategies, and learning experiences that shaped their positions and experiences teaching high school students sexuality education. The research team utilized extant literature in the theory of teacher development, as well as published sexuality education program literature, to provide a foundation for the interview questions (Cense et al., 2020). Prior to data collection, the research team translated the interview guide from the original English version to Japanese using a cross-cultural language translation technique (Banville et al., 2000). The interviews lasted 60 to 90 minutes each, and questions were carefully worded to ensure relevancy to the teaching environment and teaching experience. Interview question examples include: a) Thinking back to the first experiences you had teaching sexuality education, how prepared were you for teaching high school students?, b) When thinking about teaching sexuality education in your health education classes, what topics were you confident enough to teach, and what topics did you lack confidence in teaching?, c) How did you try to improve the quality of your lessons? d) What is your ideal image of effective teaching in sexuality education classes?, and e) What kind of resources or trainings help you to be an effective teacher of sexuality education?

Data analysis
A constant comparative method (Boeije, 2010) was used to interpret the data. The basic strategy of this analytical process is to constantly compare pieces of data while inductively deriving meaning or themes. More specifically, the transcripts from the set of interviews with each participant were coded independently by the researchers, then the research team came together to discuss the differences until agreement was reached in relation to themes. Two peer debriefers reviewed the codes to avoid potential researcher bias. In addition, coded data from the sets of transcripts from each participant were compared to identify similarities and differences. For example, after peer debriefing, the researchers conducted a second round of coding key terms in the transcripts (e.g., instruction, behavioral management, ethics), by recoding the original sources. Some codes were combined during this process, whereas others were split into subcategories (subthemes). Finally, all data and definitions of key terms were sent back to the participants for member checking. After confirmation from all participants was received, the researchers grouped the codes into thematic categories, and the data was refined into recurring themes (Boeije, 2010).

Results
The purpose of this study was to describe and explain Japanese health and physical education teachers' experiences teaching sexuality education at the high school level.
These participants had less than five years of teaching experience in sexuality education at the high school level. They felt that they were not well-prepared; faced barriers in delivering effective instruction; and had concerns about student, parent, or administrator responses. Moreover, they were not confident to meet high school students' relevant needs, and struggled to design activities to meet these needs (Barr et al., 2014). Although they felt that they should create a safe learning environment and foster student comfort when they were discussing sensitive topics in sexuality education, they lacked the confidence and skills to adequately create this environment. Three major interrelated and complex themes emerged from the data analyses: (a) teaching how to avoid unwanted and unexpected pregnancy, (b) be careful about sexual comments and terms that could turn to harassment, and (c) use instructional resources that help students' transformative learning. These themes illustrate the participants' teaching experiences of sexuality education at their high schools in Japan.

Theme one: Teaching how to avoid unwanted and unexpected pregnancy
This first theme represented participant thoughts, feelings, and experiences related to the importance of teaching students how to prevent unwanted and unexpected pregnancy, even though the topic may challenge, or be in opposition to, the content in the health education curriculum. All participants felt that although there were not goals and objectives identified in their school curricula related to pregnancy, they believed it was important to teach how to avoid unwanted and unexpected pregnancy, because the care system for women in Japan is quite underdeveloped and limited. Mr. Nimo, for example, asked his students to complete a form related to their expectations and experiences in his sexuality education unit, and shared that: My students completed the survey forms and submitted them before we started the classes, and at the end of the classes. They honestly suggested to me that I need to include the content of how to avoid unwanted and unexpected pregnancy in sexuality education. My students knew that unwanted and unexpected pregnancy would make them change their life goals and plans drastically. Another student wrote that I should teach various types of protection, and that I also need to teach how to use pills after unprotected sex. It is important to learn the concept. (Mr. Nimo, interviews) Mr. Nimo believed that it was beneficial to assess and evaluate students' learning outcomes before and after the sexuality education classes. Another participant, Mr. Ichijo explained that when he taught sexuality education, he googled the current data related to sexual behaviors and teenage pregnancy, and facilitated discussion opportunities for students to think about their decisionmaking processes related to sexual behaviors. He said: I used various data including teenage pregnancy rates, abortion rates, age of first sexual intercourse experience, and so on while I was teaching sexuality education. I want my students to take responsibility and make the right decisions about their sexuality, behaviors, and actions. Therefore, using the evidence-based data is such an important approach for my students during the class. They need to think about their own consequences when they have teenage pregnancy, and/or abortion. Having a baby changes their life plans drastically, so as the teacher, I will continue to use the evidence-based data for my classes. (Mr. Ichijo, interviews) Mr. Ichijo, Mr. Nimo, and Ms. Hikawa believed that all health and physical education teachers must follow national performance standards (MEXT course of study), as well as guidelines provided by their school districts. However, they shared that they often need to select and cover sexuality content that is not a part of the course of study, which allows them to meet their students' unique needs. For example, Ms. Hikawa said: I wanted to cover how to avoid unwanted and unexpected pregnancy and how to use pills as their own protection. Taking oral contraceptive pills after unprotected sex during 72 hours may decrease the chance of having pregnancy, but this information I am not supposed to cover based on the course of study, but it may be useful, helpful, and beneficial for my students. I am a female teacher and I need to teach students how to protect themselves from unwanted and unexpected pregnancy. I also know that taking pills helps female students have better balance between their menstruation and hormones. I think there are many beneficial pieces of information that I should use in my sexuality education classes, but I have the dilemma that I may cross the line and teach content that could turn into a controversial discussion between teachers and students. I am scared to teach sexuality education content sometimes. (Ms. Hikawa, interviews) Ms. Hikawa was afraid that she may receive complaints from her students' parents about her sexuality education lessons. Because of parent complaints and feedback in Japan, there have been calls for a focus on pregnancy to be removed from the sexuality education curriculum (JOICFP, 2022). Health and physical education teachers being hesitant to teach topics related to pregnancy and abortion, like Ms. Hiwaka, is showcased in the work of Sato, Kataoka, McKay et al., 2022).

Theme two: Be careful about sexual comments, behaviors, and terminology that could turn to harassment
The second theme captured the overarching feeling that all participants felt related to carefully navigating the use of sexuality-based terminology, explanations, behaviors (including gestures), and clarifying comments during health education classes. The participants observed that their students often shared unwanted, threatening, offensive, or inappropriate jokes and sexually charged comments during the classes when sexuality content was being covered. Therefore, they tried to carefully communicate strategies for decreasing unpleasant behaviors, while increasing respectful and caring behaviors among the students when covering sexuality education content.
Related to teacher development, Zidonis (2004) shared that teachers believe a role model in the classroom must emphasize communication, observation, and behavior management, because these are the characteristics of a "good to great" teacher that represent the cultural and value system in Japanese high schools. However, when the teachers feel that they have failed to meet their students' expectations of a role model, they suffer from mental stress, develop negative dispositions for participating in tasks, and label themselves as a "bad teacher" in sexuality education. Ms. Hikawa explained: When I taught sexuality education, some of my students teased and shared inappropriate jokes which turned to sexual harassments in the classes. I tried to stop them, so that they did not escalate comments and behaviors toward other students. I also tried to give warnings when some students were out of control. However, I had to be careful with what I said and how I explained the content and terminology of sexuality education that turned to harassment, so I needed to teach more about caring and respectful behaviors toward others in the classes. (Ms. Hikawa, interviews) Ms. Hikawa shared that "I understand the mood swings of the female monthly menstrual cycle and pregnancy, so I can give comments from the female viewpoint in sexuality education." In contrast, Mr. Nimo did not know how to communicate with female students when they needed to be absent from physical education when they had their monthly menstrual cycle. He said: When I shared about the female monthly menstrual cycle, I could teach the content, but I paid attention to female students' reactions during the class, and they were negative. It reminded me that when I taught physical education classes, there were students who needed to be absent from PE classes because of their monthly periods and pains. I had doubts that these students simply just did not want to participate in PE classes. I wanted to ask more detail, but I always had a concern that my further questions may turn to sexual harassment. I also shared with my students during sexuality education classes that sometimes I had to ask female students to show their ears during physical education classes, to make sure that female students removed their earrings for safety. I explained that my behavior may be considered sexual harassment, helping my students understand how careful I have to be when teaching this content. (Mr. Nimo, interviews) Mr. Nimo believed that it was ethical to ask for a rationale related to absences from physical education, however, he was anxious that his questions and comments may emotionally harm his female students and may be perceived as abusive or harassing behavior. Another participant, Mr. Tadokoro, believed that sexual harassment often occurred when students and teachers communicated through social network services (e.g., twitter). He said: I have seen several cases were sexual harassment occurred when students and teachers communicated through social network services. In my sexuality education classes, I divided the students into several groups and allowed them to discuss how to prevent sexual harassment on social network platforms within their groups, and share with other students at the end of class. I think it is important to share several cases and allow them to think about harassment, abusive behaviors, verbal interactions, and gender discrimination. I also teach how to use social network services in an appropriate manner. (Mr. Tadokoro, interviews) Mr. Tadokoro felt that it is important that his students were given the opportunity to talk about how to support one another when they saw other students' inappropriate behaviors. Not only did the students discuss through their own experiences, they also learned from the experiences of their peers, and had the opportunity to explore action and change in their group discussions.

Theme three: Use instructional resources that help students' transformative learning
Transformative learning incorporates a teacher identifying limits in their approach to instruction, reflecting critically on assumptions, and examining new approaches and perspectives (McGonigal, 2005). The third theme captured the way the health and physical education teachers relied on various instructional resources including visual and conversational methods when they felt embarrassed or struggled to teach controversial content in sexuality education classes, and the manner in which transformative learning governed their instruction-based decisions. For example, the use of videos as instructional tools helped and enhanced teachers' instructional quality and allowed students to understand social phenomena related to uncomfortable topics and discussions in sexuality education. In teacher development, when teachers introduce and discuss controversial topics in sexuality education utilizing videos, there are risks that the content of the videos may fail to elicit a sufficient range of views from students, in which the sexuality education lesson may require the teachers to intervene. According to Outlon et al. (2004), teachers make judgements about what information to present, and such judgements about controversial issues are generally subjective. Mr. Sumi explained: I used video clips from YouTube when I had difficulty teaching sexuality content. For example, I wanted to teach the importance of fate. In the video clip, there were two young boys who suffered from childhood cancer. I do not think I would be able to teach sexuality content without visual methods. Using visual methods is powerful and changes students' lives. Without showing the videos, I would be embarrassed to teach sexuality education. If I cannot teach certain and specific topics, I rely on YouTube video clips. (Mr. Sumi, interviews) Mr. Sumi explained that YouTube videos provided certain scenarios that constitute examples of learning about sexuality for high school students. Another participant, Mr. Ichijo said: I did not think I would be able to explain enough when I taught my students how to use protection, so I found several video clips from the internet to support my teaching. The clips showed several doctors who are obstetrician gynecologists, and demonstrated how to use protection regarding what and how to do it, and what and how not to do it. It seemed that these doctors explained the content well, because I received positive feedback from students. I am not confident and feel embarrassed when I use sexuality related terminology. I am not comfortable to use these words. However, these doctors made their lectures more interesting and bonded with the audience. I do not think I will be able to teach like them at this moment, so I felt it may be ok to use visual methods. (Mr. Ichijo, interviews) Mr. Ichijo also felt that he should use other experts (e.g., doctors, health specialists, psychologists, and social workers) and rely on their visual aids and methods as additional options for his instruction in sexuality education. He felt that relying on experts through videos and other visuals was important to enhancing the quality of his instruction in sexuality education. Mr. Sumi and Mr. Ichijo prepared a set of procedures that include: (a) formulating sexuality education lessons that satisfy students' needs and (b) using various instructional methods that maximize their students' learning experiences in classroom activities (Katz, 1977).
Also related to instruction, Mr. Tadokoro shared about the opportunity he had related to learning the technique of organizing and facilitating a group discussion. He said: My colleagues (other teachers) taught me how to pair students in group discussions. I wanted my students to discuss with peers from diverse backgrounds. For example, I do not think it is good idea that I allowed male or female students to find group partners, because they sought their comfort zone. I wanted them to find students with different genders and backgrounds, share their stories, and engage together in learning in my class. That is the most important. When I teach sexuality education, I should not feel pressure that I had to lead everything. I need to serve as a facilitator rather than a teacher of sexuality education lessons, so that students have more opportunities to engage in the content through social interactions. (Mr. Tadokoro, interviews) Mr. Tadokoro mentioned that a professional community is the single most important factor for instructional improvement in teacher development, where teachers participate in decision making, have a shared sense of purpose, and engage in collaborative work.
He also believed that it was important that his students were required to step outside of their comfort zones and into personal growth experiences through the learning activities in his sexuality education classes. He believed that his students' experiences, comfort, learning, and growth would develop through meaningful group discussions in his class.

Discussion
The purpose of this study was to describe and explain Japanese health and physical education teachers' experiences teaching sexuality education at the high school level. In line with the theory of teacher development, teachers in this study had different perspectives and ideas about what teaching involved (Grossman, 1994). They believed it was important to select relevant content to meet student needs, and offer engaging learning opportunities related to sexuality education to help students develop health enhancing behaviours and limit health risk behaviours (Atwood et al., 2012). The teachers also believed that it was important to teach several concepts related to contraception and safe-sex practices to prevent unexpected and unintended pregnancies in sexuality education lessons.
In Japan, unintended pregnancies are reflected in Japan's abortion statistics, which show an increase in the abortion rates among young women and teenagers (Baba et al., 2005). With regard to unwanted or unintended pregnancies, the pregnancy intention of the mother influences the mental health of the child (Goto et al., 2006). More specifically, the number of child abuse cases are sharply increasing, because many younger parents suffer from poverty, personality problems, parental conflict, social isolation, and family problems (Tanimura et al., 1995). Therefore, the teachers believed that promoting sexuality education successfully provided knowledge and information related to a positive future for high school students. In order to prevent the unintended and unexpected pregnancies, Ms. Hikawa discussed that she should inform her students on how to use oral contraceptive pills. In Japan, access to oral contraceptive pills requires a medical prescription, and pills cost around 6000 yen to 20,000 yen ($55-$190 USD), which is prohibitively expensive for many women, because contraception is not covered by national health insurance in Japan (Sorano et al., 2021). Although there is a safety concern that many teachers perceived (i.e. increased access to contraceptive pills discouraging condom use and increasing STIs), they thought that they were in an excellent position to identify high school students who are at high risk of pregnancy and offer knowledge and skills regarding contraceptive options. As related to the renewal stage of theory of teacher development (Katz, 1977), these teachers were motivated to modify and improve their sexuality education classes and were interested in continuously adding new twists (e.g., teaching contraceptive options) to their lessons and curriculum.
The teachers believed that they needed to be cautious regarding their instruction during sexuality education lessons, as it could be perceived as sexual harassment. They observed that female students were exposed to different kinds of sexist comments, and that many of the students taking part in teasing behaviours were male students. They also observed male to male teasing, which is aligned with research that indicated insults aimed at male students were expressed through teasing and name-calling (Odenbring & Johansson, 2021). Teasing is defined as a playful act between friends, but it is also an expression of dislike and a cruel act toward others (Mills, 2018). Mills and Carwile (2009) explain that teasing in educational settings vary, with different kinds of social interactions displaying complex patterns in relation to social class, gender, and teasing behaviours. In this study, the teachers struggled with their students' sexual comments of "just joking" which made it difficult for the teachers to recognize harassment and bullying. This concept is indicated in research related to teachers knowing when to act and how to support students who are involved in teasing behaviours (Rawling, 2017).
According to Haywood et al. (2017), although teachers may become cautious and hesitant in dealing with sensitive topics related to sexuality and sexuality behaviours, they need to consider and listen seriously to students' definitions and perceptions of teasing behaviours (e.g., namecalling), so that they may be able to prevent the negative impact on peers, as well as power differentials and violence. Related to teacher development, teachers need to foster a positive classroom atmosphere, whereby they facilitate discussions to deal with teasing and sexual harassment and help high school students to develop skills in problem solving, develop social skills, and build empathy (Mishna et al., 2005).
Participants in this study felt that it was obvious that teacher-student relationships are power structures, and were afraid that their comments and suggestions might escalate into sexual harassment claims. Sexual harassment is defined as a continuum of abusive behaviour, and these claims are evident when an abuse of power creates negative effects on high school students (Fineran & Bennett, 1998). This continuum includes many different behaviours from mild to severe forms of unwanted sexual attention or sexual violence, which accounts for significant overlap in the categories (Timmerman, 2003). In the consolidation stage of teacher development, teachers need to give comments or feedback that meet the needs of the students in the class (Katz, 1977). More specifically, when teachers value and connect learning tasks to their students' own behaviors and actions in a purposeful manner, the students are more willing to meet the demands of achievement (Moeller et al., 2012). Therefore, the teachers should utilize student behaviors and actions as teachable moments, and encourage their students to generate self-reflective understanding and critical analysis of their own behaviors and social relationships (Sergiovanni, 2000).
The teachers were comfortable leading particular types of instructional activities that were integral to sexuality education. However, variability in teacher preparedness, self-efficacy, comfort levels, enthusiasm, and motivation significantly impacted the lesson implementation and outcomes (Dickson et al., 2019). Similar to research published by Wang et al. (2015), when the teachers in this study were uncomfortable teaching certain sexuality education class materials, they answered students' questions with a lack of confidence and skill. According to Sato and Hodge (2017), teachers should implement culturally relevant lessons or activities in sexuality education using five dimensions: attitudes, learning, climate, curriculum, and family involvement. In addition, teachers should focus on effective intercultural communication and the infusion of social justice content and concepts into sexuality education curricula (Burden et al., 2012;Columna et al., 2010). In addition, they were anxious about teaching sexuality content using cognitive and behavioural strategies, such as skill practice with observational feedback, which is in concert with research published by Joyce et al. (2004).
To help feel more comfortable with lesson delivery, teachers in this study used various instructional methods (e.g., video clips and group discussion) that applied the content to real-life settings. For example, YouTube videos were presented as a useful instructional tool to cover sexuality education content, which is supported by the work of Firpo-Triplett et al. (2014). Reynolds et al. (2021) explained that video presentations or visual learning are more effective than standard lectures for high school students, because video clips not only help the teachers become knowledgeable on certain topics related to sexuality education, but also break down how to deliver the content to high school students into a series of smaller steps. In the renewal stage of teacher development, teachers are striving to improve their classes and are interested in continuously adding new twists to their lessons and curriculum (Katz, 1977). For example, the teachers may use additional visual aids for improving lessons and curriculum that meet high school students' unique learning needs (McEldoon & Rittle-Johnson, 2010). Additionally, the teachers felt that using the group discussion format in sexuality education benefited their students. The purpose of the group discussion is to allow the students to have practice in discovering through gathering new knowledge, sharing their own perspectives, and reflecting on their own learning (Banchi & Bell, 2008). In this study, the teachers found that the students could more easily understand the concepts when they were developed through active discussion and exploration, rather than when the concept was presented by the teacher in a direct instruction format.
The teachers must pay attention that their students shape and constrain honest conversations (e.g., sharing honest opinions and personal weakness) so that they develop knowledge, interests, and rhetorical expectations in the sexuality education realm (Sato & Hodge, 2015). For example, culturally, Japanese students received more than simple or no judgmental responses or feedback (such as right or wrong) during the group discussion, which is highlighted by Song and Hill (2007) as one aspect of encouraging self-directed learning. These benefits of discussion and engagement are supported by Talib et al. (2015), as well as Carrasco and Torres Irribarra (2018), who shared the benefits of discussions, including the ability of the teacher to observe students discuss academic content, social issues, and behavioural characteristics.

Study limitations
This study has three major limitations. First, the participants were selected from only five public high schools in Japan. Having more than five high schools would have enabled this study to adopt an efficient cross-case analysis, which could extend the investigator's expertise beyond the single number of cases (Stretton, 1969). Second, generalizability may be limited with this study. While qualitative research findings are not necessarily intended to be generalizable, as they instead they focus on in-depth meanings and explanations, generalizability is still limited. In this study, the findings are specific to five participants in Japan, but may provide insights that are useful for health and physical education teachers in similar locations (Eckstein, 2002). Third, the number of participants was small, and while they had a wide range of backgrounds and experiences in sexuality education, additional participants would strengthen the study, and expand the breadth of the understanding of experiences related to teaching sexuality education.

Recommendations and conclusions
The results of this study demonstrate that health and physical education teachers used various strategies for meeting students' unique needs while teaching sexuality education. Based on the findings of this study, a number of concerns were raised, and as such, the following recommendations are intended to enhance the quality of sexuality education for high school students.
First, the teachers believed that their students' lack of knowledge makes education and consulting on sex, reproduction, and contraception necessary (Wang et al., 2015). To teach how to prevent unwanted pregnancy, teachers should teach emergency contraception methods (Kongnyuy et al., 2007). This study also recommends promoting sexuality education for the parent population as a means to bridge the gap between school curricula and parent perspectives. In Japan, parents tend to avoid discussing topics such as love, premarital sexual intercourse, contraception, and abortion with their children (Amin-Shokravi et al., 2009). Therefore, high schools and health and physical education teachers need to promote sexuality education for the parents.
In addition, this study found that the role of Japanese health and physical education teachers in creating harassment free school environments was problematic. To prevent sexual harassment (including teasing and/or bullying), the teachers must address the ethical agenda in the sexuality education classes rather than punishing or penalizing their high school students. Timmerman (2003) explained that it is important that the teachers have professional training in being a moral guardian, and study their own unprofessional pedagogical behaviors related to teaching sexuality education to high school students.
Third, the teachers relied on video clips as one of their education resources when they were uncomfortable teaching certain content in the sexuality education curriculum. Allen (2009) suggests that teachers ask their students to choose photos they want to discuss, to give an opportunity for students to take a leadership role in the classroom environment, contributing to the discussion agenda, and prioritizing issues they perceive to be important. Teachers must employ a student-led cooperative learning strategy that allows their high school students to analyze and discuss the suitability of topics related to sexuality education (Talib et al., 2015). The purpose of group discussion is to encourage high school students to be open minded, flexible, and willing to solve problems together.
Lastly, this study recommends that the MEXT may need to develop sexuality education policies that focus on comprehensive sexuality education requirements rather than abstinence-only content requirements at the high school level. This change in focus would allow MEXT to address and incorporate content and themes related to social justice and diversity, including religion, disability, LGBTQ, sociocultural, and socioeconomic issues. This idea of a proposed policy may change and redefined characteristics could impact inclusive health and wellness across Japan.
This study explored a small group of Japanese health and physical education teachers' experience teaching sexuality education in the high school setting. Findings suggest that health and physical education teachers responsible for sexuality content must be ethical teachers who demonstrate attitudes and actions focused on what is best for their students. In order to advance the quality of sexuality education instruction, teachers, administrators, and researchers need clear and focused goals related to the status, quality, and relevance of sexuality education programs and curricula. Due to the paucity of research in this area, it is essential to further explore these issues in Japan.